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Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.

The present study aimed at exploring associations among meal-related behaviour,social engagement factors, satisfaction with food-related life (SWFL) to assessfood-related wellbeing and subjective wellbeing in Danish older adults living alone. Three hundred and eighty-eight older adults aged 65–75 years from sixDanish municipalities completed an online or article-based survey addressinghome cooking, commensality, loneliness, SWFL and subjective wellbeing. Homecooking frequency and self-perceived cooking skills were positively associated with SWFL but not with subjective wellbeing. Commensality was positively associated with SWFL but was not associated with subjective wellbeing. The level of loneliness was negatively associated with SWFL and with subjective wellbeing.Satisfaction with food-related life and subjective health status were positivelyassociated with subjective wellbeing. Male and female respondents did not differin meal-related behaviour, social engagement factors, SWFL and wellbeing.While the cross-sectional nature of this study does not allow for the direction ofcausality to be determined, these results suggest that older adults living alonecould benefit from a higher frequency of home-cooked meals, a higher level ofself-perceivedcooking skills and commensality to support SWFL. A higher levelof SWFL could, in turn, lead to a higher level of wellbeing. The present study aimed at exploring associations among meal-related behaviour, social engagement factors, satisfaction with food-related life (SWFL) to assess food-related wellbeing and subjective wellbeing in Danish older adults living alone. Three hundred and eighty-eight older adults aged 65–75 years from six Danish municipalities completed an online or article-based survey addressing home cooking, commensality, loneliness, SWFL and subjective wellbeing. Home cooking frequency and self-perceived cooking skills were positively associated with SWFL but not with subjective wellbeing. Commensality was positively associated with SWFL but was not associated with subjective wellbeing. The level of loneliness was negatively associated with SWFL and with subjective wellbeing. Satisfaction with food-related life and subjective health status were positively associated with subjective wellbeing. Male and female respondents did not differ in meal-related behaviour, social engagement factors, SWFL and wellbeing. While the cross-sectional nature of this study does not allow for the direction of causality to be determined, these results suggest that older adults living alone could benefit from a higher frequency of home-cooked meals, a higher level of self-perceived cooking skills and commensality to support SWFL. A higher level of SWFL could, in turn, lead to a higher level of wellbeing.

The aim of the study was to determine the effects of a multi-component community-based health promotion intervention on body mass index (BMI) z-scores and waist circumference (WC) in three- to eight-year-old children. A quasi-experimental design was adopted to evaluate the effects of the SoL intervention involving three intervention and three control communities. The 19-month intervention was based on the supersetting approach and was designed to promote healthier eating and physical activity among children and their families. BMI z-scores and WC were measured at baseline and follow-up. At baseline, 238 (54%) and 214 (51%) of all eligible children were measured from intervention and control, respectively. The change over time in the BMI z-scores of children from the intervention group was significantly different from that of the control group (p = 0.001). BMI z-scores increased over time in the intervention group in contrast to the control group, whose BMI z-scores decreased (difference in change between groups 0.19 z-scores 95% CI 0.08, 0.30). No significant differences were observed for WC. The results showed no favourable effects of the intervention of Project SoL on BMI z-scores and WC in children. Further studies based on a larger sample size and a longer intervention duration are needed.

Objectives: The objective of the present study was to investigate the relationship between price and sales volume of non-alcoholic sugar-sweetened beverages (SSBs), diet drinks, sweets and chocolates, including own and cross price elasticity to further quantify the potential impact of price. Methods: The study was based on retail scanner data for grocery sales from retail outlet chains in Denmark during the year 2008–2015. A fixed-effects model was used to estimate the association between price and sales volume, using own price and cross price elasticity. Results: Sales volume of all sugary products except for chocolates were significantly negatively associated with price. Own price elasticity varied from −0.3 to −0.4 for drinks and sweets indicating that a 10% increase in price would cause a reduction in sales by 3 or 4%. A 10% increase in price of carbonated SSBs would increase sales of diet drinks by 7%. Cross price elasticities for other products were not significant. Conclusions: The results of the present study demonstrated significant negative associations between changes in price and changes in the sale of SSBs, diet drinks and sweets.

A quasi-experimental study was designed to promote novel plant-based dishes using the nudging strategy ‘dish of the day’ among older consumers in Denmark, France, Italy and the United Kingdom. Participants were presented with three dish options: veggie balls, meatballs and fish cakes. In the intervention situation, participants were informed that the ‘dish of the day’ was the novel plant-based ‘veggie balls’. Thereafter, participants were asked to choose one of three dishes to intake and then fill a questionnaire. No statistically significant difference in dish choice was found between the control group and intervention group in the four countries. Males were less likely to choose the plant-based dish when compared with the females. Participants from the United Kingdom and Denmark were more likely to choose the plant-based dish when compared with participants from France. High scores of security dimension from the Human Value Scale was negatively associated with choice of plant-based dish, while high scores of the sensory dimension from Food Choice Questionnaire and high scores of the universalism dimension from Human Values Scale were positively related to the choice of the plant-based dish. The ‘dish of the day’ nudging approach did not influence older people’s plant-based dish choice. Gender, country, and dimensions of sensory, universalism and security were critical factors influencing an older people’s plant-based food choice.

The objective of the present study was to investigate the relationship between price and sales volume of non-alcoholic sugar-sweetened beverages (SSBs), diet drinks, sweets and chocolates, including own and cross price elasticity to further quantify the potential impact of price.The study was based on retail scanner data for grocery sales from retail outlet chains in Denmark during the year 2008-2015. A fixed-effects model was used to estimate the association between price and sales volume, using own price and cross price elasticity.Sales volume of all sugary products except for chocolates were significantly negatively associated with price. Own price elasticity varied from -0.3 to -0.4 for drinks and sweets indicating that a 10% increase in price would cause a reduction in sales by 3 or 4%. A 10% increase in price of carbonated SSBs would increase sales of diet drinks by 7%. Cross price elasticities for other products were not significant.The results of the present study demonstrated significant negative associations between changes in price and changes in the sale of SSBs, diet drinks and sweets.

Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3&ndash, 8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Interventions are implemented in childcare centres, schools and supermarkets in three local communities as well as in local mass media and social media during a 19 months period in the Municipality of Bornholm. The matching Municipality of Odsherred serves as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. The formative research comprises studies on children&rsquo, s perceptions of health, perceptions of staff at supermarkets and media professionals on their roles in supporting the health promotion agenda, and motivations and barriers of community stakeholders to engage in health promotion at community level. The paper discusses operational issues and lessons learnt related to studying complex community interventions, cross-disciplinarily, interfaces between practice and research and research capacity strengthening, and suggests areas for future research. The development and implementation of the intervention and its theoretical foundation is described in a separate paper.

Project SoL was implemented over a period of four years from 2012&ndash, 2015 with the aim to promote healthy eating and physical activity among families with children aged 3&ndash, 8 years, living in selected communities in two Danish municipalities. This was done by applying the supersetting approach to implement complex multi-component interventions in a participatory, coordinated, and integrated manner in childcare centres, schools, and supermarkets in three local communities, as well as in local media during a 19-month period in the Regional Municipality of Bornholm, which served as the intervention site. The matching municipality of Odsherred served as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper describes the design of Project SoL as well as the processes of developing and implementing its complex interventions. Moreover, the theoretical and conceptual framework of the project is described together with its organisational structure, concrete activities, and sustainability measures. The paper discusses some of the key lessons learned related to participatory development and the implementation of a multi-component intervention. The paper concludes that coordinated and integrated health promotion activities that are implemented together with multiple stakeholders and across multiple settings in the local community are much more powerful than individual activities carried out in single settings. The supersetting approach was a useful conceptual framework for developing and implementing a complex multi-component health promotion intervention and for fostering ownership and sustainability of the intervention in the local community. The research and evaluation approach of the project is described in a separate paper (Part 2).

Fruit consumption is associated with a decreased risk of CVD in cohort studies and is therefore endorsed by health authorities as part of the ‘5 or more a day’ campaigns. A glass of fruit juice is generally counted as one serving. Fruit may cause protection by affecting common risk factors of CVD. Apples are among the most commonly consumed fruits and were chosen for a comprehensive 5 × 4 weeks dietary crossover study to assess the effects of whole apples (550 g/day), apple pomace (22 g/day), clear and cloudy apple juices (500 ml/day), or no supplement on lipoproteins and blood pressure in a group of 23 healthy volunteers. The intervention significantly affected serum total and LDL-cholesterol. Trends towards a lower serum LDL-concentration were observed after whole apple (6.7 %), pomace (7.9 %) and cloudy juice (2.2 %) intake. On the other hand, LDL-cholesterol concentrations increased by 6.9 % with clear juice compared to whole apples and pomace. There was no effect on HDL-cholesterol, TAG, weight, waist-to-hip ratio, blood pressure, inflammation (hs-CRP), composition of the gut microbiota or markers of glucose metabolism (insulin, IGF1 and IGFBP3). Apples are rich in polyphenols and pectin, two potentially bioactive constituents; however, these constituents segregate differently during processing into juice products and clear juice is free of pectin and other cell wall components. We conclude that the fibre component is necessary for the cholesterol-lowering effect of apples in healthy humans and that clear apple juice may not be a suitable surrogate for the whole fruit in nutritional recommendations.

ObjectiveTo assess the relative validity and reproducibility of the semi-quantitative FFQ (SFFQ) applied in the evaluation of a community intervention study, SoL-Bornholm, for estimating food intakes.DesignThe reference measure was a 4 d estimated food record. The SFFQ was completed two times separated by a 1-month period in order to test reproducibility.SettingThe Capital Region and the Regional Municipality of Bornholm, Denmark.SubjectsA total of fifty-four children aged 3–9 years were enrolled in the study.ResultsIn terms of validity, the SFFQ generally overestimated intakes compared with the food records, especially for vegetables. For most intakes, the mean difference increased with increasing intake. Gross misclassification was on average higher for energy and nutrients (17 %) than for foods (8 %). Spearman correlation coefficients were significant for twelve out of fourteen intakes, ranging from 0·29 to 0·63 for foods and from 0·12 to 0·48 for energy and nutrients. Comparing the repeated SFFQ administrations, the intakes of the first SFFQ were slightly higher than those of the second SFFQ. Gross misclassification was low for most intakes; on average 6 % for foods and 8 % for energy and nutrients. Intra-class correlations were significant for all intakes, ranging from 0·30 to 0·82 for foods and from 0·46 to 0·81 for energy and nutrients.ConclusionsThe results indicate that the SFFQ gives reproducible estimates. The relative validity of the SFFQ was low to moderate for most intakes but comparable to other studies among children.

SummaryEvidence suggests that a high intake of fruits is associated with a reduced risk of cardiovascular disease (CVD) and lowered plasma cholesterol, but the specific effects of individual types of fruit, fruit fractions, and processed fruit are less well-studied. Apples are among the most frequently consumed fruits, and human and animal studies on apple may help to clarify the effect of this fruit on CVD risk markers. The aim of this mini-review is to summarise current evidence for a lowering effect of apple on the risk of CVD and plasma cholesterol levels, and to investigate whether such an effect is influenced by fruit processing or the form of intake. Possible mechanisms behind the cholesterol-lowering effect of apples are also considered. All relevant published experimental studies in humans and animals were identified within the open literature. Nine human studies were identified, of which four concerned the effects of whole apples, two the effects of dried apples, and three the effects of filtere...

Background Research shows that obesity prevention has to start early. Targeting interventions towards subgroups of individuals who are predisposed, but yet normal weight, may prove more effective in preventing overweight than interventions towards unselected normal weight subsets. Finally, interventions focused on other factors than diet and activity are lacking. The objectives were to perform a randomized, controlled intervention aiming at preventing overweight in children aged 2–6 years, who are yet normal weight, but have high predisposition for future overweight, and to intervene not only by improving diet and physical activity, but also reduce stress and improve sleep quality and quantity. Methods/Design Based on information from the Danish National Birth Registry and administrative birth forms, children were selected based on having either a high birth weight, a mother who was overweight prior to pregnancy, or a familial low socioeconomic status. Selected children (n = 5,902) were randomized into three groups; an intervention group, a shadow control group followed in registers exclusively, and a control group examined at the beginning and at the end of the intervention. Approximately 21% agreed to participate. Children who presented as overweight prior to the intervention were excluded from this study (n = 92). In the intervention group, 271 children were included, and in the control group 272 were included. Information obtained from the shadow control group is on-going, but it is estimated that 394 children will be included. The intervention took place over on average 1½ year between 2009 and 2011, and consisted of optional individual guidance in optimizing diet and physical activity habits, reducing chronic stress and stressful events and improving sleep quality and quantity. The intervention also included participation in cooking classes and play arrangements. Information on dietary intake, meal habits, physical activity, sleep habits, and overall stress level was obtained by 4–7 day questionnaire diaries and objective measurements. Discussion If the Healthy Start project is effective in preventing excessive weight gain, it will provide valuable information on new determinants of obesity which should be considered in future interventions, and on new strategies to prevent development of overweight and obesity at an early age. Trial registration ClinicalTrials.gov, ID NCT01583335.